Tramadol, Depression, What Now?

Hello.  

First, thanks to all those that post on this board, I've read many threads here about Tramadol addiction and they've been most helpful, and helped make this detox less hellish.

The reason I'm posting this new thread rather than adding to the already plentiful threads revolving around the same subject is because I have some additional concerns not already covered in the other posts.  I want to know what comes [i]after[/i] the Tramadol.  First, a little background:

I've been using Tramadol now for a couple years, and my regular dosage is around 500mg - 800mg daily.  That's 10 - 16 pills daily, vastly exceeding the maximum recommended dosage.  I am currently detoxing CT (thanks to all those in the other threads with information and recommendations on how to undergo this process), and my last dose was about two and a half days ago.  Suffering from all the usually goodies, with the "fatigue coupled with leg-twitching that won't let you rest" featured most prominently.  But that isn't why I'm writing this post.

I never started using Tramadol due to pain.  I took it to manage my mood.  I'm not sure what the cause of my general low-mood is, but it's always been there, and I've always been trying to figure out a way to live my life normally.  I enjoyed opiates, but they were too strong, passed too quickly, and were too dangerous.  I tried kratom, but eventually I was taking loads of the stuff, it stopped working and it was expensive.  Next came Tramadol, which I tried out of desperation after quitting the kratom.

It was like a miracle.  I felt so. much. better.  I had energy, I could be with people socially, got a girlfriend, did well at work, felt focused and my depression was totally gone.  To an extent, Tramadol still works, and I can take 12 pills in a day rather than 16 and still feel ok.  The main benefit it's had on me that is that I have zero depressive episodes since I started with the drug.  

Now I'm quitting.  Actually, when I decided to detox a few days ago, I only wanted to "take a break" and reset my tolerance.  I've done this before.  But then I read all these threads here and on other boards where people quit and their lives improve.  Logically I know it just can't possibly be good to be taking this much of any medication, health-wise at the very least.  But what really scares me is life [i]after[/i] Tramadol.  People talk about how "it feels so good to be myself again!", but I don't [i]want[/i] to be my old self.  My old self sucked.  I had no motivation, performing even simple tasks (cleaning, bills, etc) were struggles that I would procrastinate endlessly to avoid doing.  I don't want to go back to that again.  I'm not sure I [i]can[/i] go back to that.

So I guess I don't really know what I'm asking.  In what ways is Tramadol like an anti-depressant?  Which anti-depressants behave in a similar way?  I would love it if I could just live my life without taking any pills, but nothing has ever worked for me.

I'm really scared.

[keter]

First of all, I'm not a doctor and have zero experience with Tramadol (though plenty of experience with opiates in general), but I do have some self-taught medical knowledge concerning neurotransmitters.
After looking at Wikipedia, trying to answer your question, it seems to me the best non-opioid  anti-depressant 'replacement'  for Tramadol are the drugs known as SNRIs. Well known examples are Effexor and Cymbalta.

Alternatively, since you mentioned you didn't like the strength and short duration of opiates*, you could look into longer acting opiates like methadone which has a half-life of between 15-60 hours (some people metabolise methadone a LOT faster than others).

Sources:
http://en.wikipedia.org/wiki/Tramadol
http://en.wikipedia.org/wiki/Serotonin-norepinephrine_reuptake_inhibitor
http://en.wikipedia.org/wiki/Methadone

*) what is it about other opiates that makes you say they are dangerous? In my opinion all opiates are dangerous in that you can overdose on them quite easily and all opiates are addictive.

[keter]

Oh, I forgot the most important part. Please talk to your doctor :)

[Japheth]

Hey keter, thanks for the comments man, I really appreciate it.  

I've done a bit of reading, and SNRIs do seem to have a similar anti-depressant reaction on the brain.  Going to look into this.

I looked into methadone after taking some for a few weeks, and the effects were, if anything, better than the Tramadol.  That's actually what led me to the Tramadol: I looked for medication that produced similar effects.  Problem was that the only way I could secure a supply of the methadone was illegally, and that's a road I'm done traveling.  I explained my situation to a doctor, but he informed me that he couldn't prescribe the methadone and that I'd have to go to a clinic.  Another road I'd really rather not travel.

What I meant by "too dangerous, too strong" in regards to other opiates is that they felt like "getting high" as opposed to "treating my mood".  I've used a ton of opiates at various points as a recreational tool, but when I started the Tramadol I was really just trying to feel "ok" so I could go about my life without feeling so ******* sad all the time.  

I don't want to be high.  I want to be normal.  Right now it seems like kicking the Tramadol is a logical step, but I can't be sure that isn't only because I've been on them for enough years to forget how bad things were before.  Everything got so much better once I started using them, but anything that makes you this sick when you stop is a serious warning flare, no?

One impediment in this whole deal is that I don't have a doctor that I trust.  The doctor I mentioned above promised that my concerns about substance abuse and methadone would remain confidential, and he failed to live up to that promise.  

[Japheth]

Almost 4 days clean now.  Still can't sleep since my damn legs keep twitching around, but better concentration and slightly more energy.  My mood isn't doing too great, but I'm praying that like others have described, things start getting better after day 4.  All this depression **** is still freaking me out, however.

[Japheth]

Day 5.  Physical maladies significantly improved, mental state is in decline.  Bad feelings of hopelessness/regret, seeking professional aid.  Damn did I not want to do this :(

[texaslady68]

Japheth,

Unfortunately, the bad feelings/hopelessness is all part of the w/d process.  It does get better about Day 10 (for me).  It is because you are starting to feel things again.  You will also get waves of happiness; true happiness like you have not felt in a long time.

Congratulations on making it to Day 5.  The worst of the physical w/d are over and just buckle down and get through the mental.  

Good luck!

[snakejones]

Hi there--I've been on Ultram for 17 years now, and at one time I was up to 18 daily--and I'm an RN. How shameful is that?!? It's usually best to taper Ultram as it has a strong antidepressant effect (I learned that here!). Quitting ct is very risky emotionally and mentally, especially at your and my dose. I ran out once, and everything went very, very black in a hurry. Within hours I was a crying, panic-stricken wreck. I have never been depressed or suicidal in my life, and believe me, it was pretty scary what I was thinkng. Do you have the discipline to taper without the drugs being there driving you crazy? If so, is there a way you could get some more to taper down with? I tapered from 18 to 8 over a 4-month period, and it was virtually painless. I'm currently down to 4 a day. As far as antidepressants, yes, the SSNI's are a fairly good match for you because of some similarities with the chemical makeup and action of the Ultram. I wish you both success and happiness this year!

[Japheth]

Hey guys, thanks for your replies, means a lot to me =)

Texaslady - Do you suffer from major depression?  The only reason I ask is because I'm worried much more about the future moving forward than I am about the particulars of the moment.  I can withstand pretty much anything for a limited time, it's the long road ahead that concerns me.  I think maybe in normal people those moments of happiness occur, but I've never really been susceptible to happiness even before I ever touched a drug, and was the reason I started using.  


Snakejones - First of all, there's nothing to be ashamed of.  Medical professionals are frequently involved with this kind of stuff.  I remember reading a list of alcoholics who were also in MENSA.

Actually I do have the discipline, which is shocking to me.  I've got more Tram here in the house, but there's no way I'm taking it till I figure out what the hell I'm doing.  Especially after the last five days.

Also, can I ask what happens if you stop taking Tram when you're down to a low dose like what you're taking?  I've heard stories about people who taper down, but still have acute withdrawal symptoms when they make the last step and reduce their dosage to zero.  


Thanks!

[snakejones]

Good morning! Hope your day is better each day....
You are stronger than I could ever be making it to this point off that kind of Ultram dose ct! Since you don't want to try tapering, at least for now, I won't try to entice you to do that. Each of us must do what is best for us. But it is a viable, safe, and effective way for quitting while remaining comfortable. When I tapered, I had a very hectic job in the recovery room and needed to be a cheerleader for my patients. To do that, I had to remain physically comfortable as possible. That's why I did a slow taper over 4 months. That was 4 years ago, and I've never been tempted to go up again. I'm currently on 4 daily due to a further reduction from 8 daily due to orthopedic surgery 13 days ago. You know, I have no idea what happens if I were to jump off ct from 4. I've been on them for 17 years. Being that it was so horrible running out that one time, I probably wouldn't even try. Why suffer? I'd taper. Yes, I've heard that some people have an awful time coming off a low dose. We are all wired a little differently, and I truly think some folks' brains really dig the antidepressant effect combined with the pain control more than others. The human body is endlessly fascinating to me.........
Have a great day. I wish you physical comfort, emotional comfort, and yes, a few smiles today!

[Japheth]

Hi snake, thanks for the reply =)

Luckily I was in a position to isolate myself, so I stocked up on food and just said "**** it, today's the day".  I can't even imagine working for the last five days, I'm not sure it would have been possible.  Some people are crazy strong.  

I'm already so far into the detox that there's really no reason for me to go on a taper.  The physical symptoms have lessened, and I almost slept through a five hour stretch last night (huge improvement).

Still terrified of life after Tram though, not sure how to escape that =(

[keter]

You're doing great, man!
In my experience, it's true that when tapering opiates the last mgs are the hardest.
Since you are so far into detox, things can only get better. It's really a shame that your doctor betrayed your trust. I don't know how things are where you're at, but over here (Holland) a breach of confidentiality is something you can report to the inspector (oversee-er? Sorry, not a native speaker of English, can't find the correct synonym). That will of course fark up the relation with your doctor, but from what you wrote I understand that relation is already pretty much down the drain.

About life after Tram, I don't have any advice apart from the obvious: find a support group of people who have gone through similar experiences (for instance Narcotics Anonymous, they are pretty much everywhere. Btw, I'd give the Scientology group (Narcanon) a wide berth)
From my own experience, I can tell it will take a while for your brain to adjust to the new situation (no exogenous opioids). It will take a while until your brain upregulates the opiate receptors and until you adjust to the new equilibrium you can expect mood swings, insomnia, irritability etc, but also feelings of bliss for no apparent reason (other than the sun shining or something 'corny' like that), feeling energised etc.

[keter]

When I said that the last mgs were the hardest, I was referring to when I was tapering methadone. I went down from 120 mg to 40 mg in a couple of months, plateaued at 40 for a month and dropped to 5mg in a few weeks.
After that I went down one mg per week without much trouble, until I got to the last two mg where I had severe w/d symptoms. Me not being made of sterner stuff, called the dealer and went back to smoking heroine.
So now I'm back to 40ish mg of methadone and working up the courage to go into rehab for a couple of months because those last few mgs are sure to eff me up again.

[Japheth]

Hey keter,

Thanks again for your posts.  Day 7 now, and things are getting somewhat better.  I know exactly what you mean about the ups and downs, even if I'm pretty depressed a lot of the time, I do have moments where I hear a surprising sound, and then realize it's because I laughed out loud by accident at something totally corny =)

In the process of ******* myself up all these years, I also unfortunately burned a relationship with a truly fantastic person that I deeply love and it saddens me that I shut that door.  Only reason I mention it is because it's adding to my depression and confusing my mind.  I know that for now the only thing I should be concerned with is getting better and that getting romantically involved with someone while in such a volatile state is a bad bad idea, and I wouldn't let it happen even if it was an option.  Still, it burns to waste such a good opportunity just for the sake of a ******* pill.

More importantly, I think, will be treating the underlying depression that caused all this abuse.  Before Tram it was methadone, and before that pills, and before that heroin, and before that weed.  I've never been able to just *be alive* without craving something to take the edge off.  I think there must be something wrong with my brain, but I'm really not looking forward to psych evaluations and doctors pushing more prescriptions on me.  

I don't want to take another pill ever, but damn the future just scares the crap outta me if I can't fix my head.